Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

408 Abstracts ThPeB7290-ThPeB7293

XIV International AIDS Conference

Conclusions: AmB in lipid emulsions seemed to yield a dramatic reduction in
view of drug toxicity whilst the activity was retained. The tested formulation, thus,
may be considered as an alternative drug delivery to the Fungizone~.
Presenting author: Nongnuch Pongcharoenkiat, R&D Institute, Government
Pharmaceutical Organization, 75/1 Rama 6 Rd., Ratchathevi, Bkk 10400, Thailand, Tel.: [phone], Fax: [phone], E-mail: nongnuch @scientist.
com
ThPeB7290 Progressive disseminated Histoplasmosis and HIV.
Our experience in Rosario, Argentina
L.E. Negro Marquinez, D. Pietrobon, A. Greca, J. Kilstein, J. Galindez. Internal
Medicine Department, Hospital Eva Peron, Rosario, Santa Fe, Argentina
Background: Histoplasmosis is the most prevalent endemic mycosis in patients
with acquired immunodeficiency syndrome. Most of our country is endemic for the
disease. With this data we want to describe our patients with AIDS and disseminated Histoplasmosis (DH) in our Hospital and compare them with other reports.
Methods: Descriptive and retrospective analysis of 16 patients with AIDS and
DH, diagnosed in our University Hospital Eva Peron at the Medicine School of
Rosario, Argentina, from October 1993 until July 2001.
Results: 135 patients with AIDS were accepted during the time of the study,
16 (12 %) had DH. We found out that it has been the first presentation of the
disease in 12 patients characterized with fever, weight loss, muco-cutaneus compromise and polyadenophaty Almost all of them had hepatosplenomegaly (93%)
and 62.5% showed an interstitial pattern in the chest radiographs. 70% had a
CD4+ lymphocyte count less than 50 cells/ mm3. 4 died during hospitalization.
The diagnostic value of the different cultures was a 100% in skin, lymph nodes
(62.5%) and bone narrow (40%). Blood cultures were value only in 20% of the
cases. All of the sixteen initiated treatment with Anfotericin B. Only one showed
severe adverse effect, nephrotoxicity, to the drug. We replaced satisfactorily with
Itraconazol None of them were treated with HAART before the develop of DH.
Those who begun it during or after disease and had correct adherence (78%)
improved and returned to their normal activities.
Conclusions: In our Region, Disseminated Histoplasmosis is a frequent opportunistic infection that we have to keep in mind as an important differential diagnosis in patients with AIDS with low CD4+ lymphocyte count. The presence of
an interstitial pattern in the chest Rx and hepatosplenomegaly are very important
references for suspicion. Skin biopsy, followed by lymph nodes and bone narrow
cultures biopsies were the most important studies for certain diagnosis.
Presenting author: Liliana Negro Marquinez, Zeballos 291 6.A, Rosario, Santa
Fe, Argentina, Tel.: [phone], Fax: [phone], E-mail: lilynegro
@hotmail.com
ThPeB7291I Oral colonization by Candida and identification of
Candida dubliniensis in HIV infected patients.
A.G. Luque1, M.S. Biasoli2, V. Santambrosio2, M.E. Tosello2, A. Binolfi2,
H.M. Magaro2, S. Lupo3. 1 CEREMIC-Facultad de Ciencias Bioquimicas y
Farmaceuticas-Universidad Nacional de Rosario, Rosario,;
2CEREMIC-Facultad de Ciencias Bioquimicas y Farmaceuticas-Universidad
Nacional de Rosario, Rosario, Argentina; 3Primera Catedra de Clinica
Medica-Facultad de Cs. Medicas-Universidad Nacional de Rosario, Presidente
Quintana 3356-2000- Rosario
Background: Although Candida albicans (C.a.) remains the fungal species most
frequently isolated as an opportunistic oral pathogen, other yeast species are
often identified in HIV (+) individuals. C. dubliniensis (C.d.) phenotypically resembles C.a. in germ tubes and chlamydospores formation. The purpose of the
present study was to detect Candida colonization and to test for the presence
of C.d. in oral mucosa. Methods: Samples were obtained by swabbing the oral
mucosa from 37 HIV(+) patients and 53 HIV(-) individuals. We carried out direct
examination and mycological cultures. For yeast identification we used: CHROMagar Candida, chiamydospore production in Corn Meal-Tween agar and assimilation and fermentation profiles. C.d. and C.a. were differentiated by growth at
45~C on PDA, D-xilosa assimilation, the API 20C AUX system, and morphology
in Niger Seed Agar.
Results: Yeast positive cultures were obtained from 29 HIV(+) patients (78%):
18 C.a., 4 C.d., 1 C. glabrata (C.g.), 1 C. krusei (C.k.), 1 C. tropicalis (C.t.); two
species were simultaneously isolated: C.a.-C.t. in 2 cases and C.a.-C.k. and C.d.C.k., in 1 case. Yeast positive cultures were obtained from 25 VIH(-) individuals
(47%): 17 C.a., 4 C.t., 1 C.d., 1 C. parapsilopsis; two species C.t. y C.a. were
simultaneously isolated in 1 case.
Conclusions: We detected higher Candida oral colonization in HIV(+) group than
in control HIV(-) group (p<0,05). C.g. and C.k. were isolated only in HIV(+) patients). The occurrence of these species, resistant to fluconazol, could be related
with previous antifungal treatments. Six strains of C.d. were identified by phenotypic methods: 5 in HIV(+) patients (15,32% of the 33 isolated Candida strains)

while only one in control group (3,7% of the 27 isolated Candida strains). Is very
important to identify correctly C.d. from clinical samples for better understanding
the clinical and epidemiological significance of its occurrence in human infections.
Presenting author: Alicia Luque, Presidente Quintana 3356-2000- Rosario, Argentina, Tel.: [phone], Fax: [phone], E-mail: [email protected]

ThPeB7292I Discontinuation of secondary prophylaxis for
cryptococcal meningitis in HIV-Infected patients
treated with HAART: A prospective multicenter
randomized study
A. Vibhagqool1, S. SungkanuparphI, PR Mootsikapun 2, p. Chetchotisakd2
S. Tansuphaswaswadikul3, C. Bowonwatanuwong4, C. Rojanawatsirivet3,
J. Waiwaravut4, W. Chantratita1. 1Faculty of Medicine Ramathibodi Hospital,
Mahidol University, Department of Medicine, Ramathibodi Hospital, Rama 6
Road, Bangkok, 10400, Thailand; 2Faculty of Medicine, Khon Kaen University,
Khon Kaen, Thailand,; 3Bamrasnaradura Hospital, Ministry of Public Health,
Bangkok, Thailand; 4Chonburi Hospital, Chonburi, Thailand
Background: Preliminary data from small studies suggest that as with other Ols
(PCP, disseminated MAC infection, CMV retinitis, and toxoplasmosis), cryptococcal meningitis may be possible to stop secondary prophylaxis in patients whose
CD4 lymphocyte count rises with antiretroviral therapy. The prospective and largescaled study is still awaited.
Methods: A prospective multicenter study was conducted in the patients with
newly successful treatment of acute cryptococcal meningitis and on first 8-week
of secondary prophylaxis, and naive for antiretroviral therapy. A HAART regimen
including AZT, 3TC, and efavirenz was initiated. The patients were randomized to
continue (A) or discontinue (B) the secondary prophylaxis when CD4 rise above
100/uL and HIV RNA was undetectable, and sustained for 3 months. The patients
were followed up for 48 weeks.
Results: 60 patients (50 males) with mean age 32.9 (24-46) years were enrolled.
Baseline median CD4 and HIV RNA were 9 (0-147) /uL and 160874 (27900 -922000) or log 5.2 (log 4.45-log 5.96) copies/ml, respectively. 11 patients had
loss to follow-up or died before CD4 >100/uL. 3 patients had relapse of cryptococcal meningitis when CD4 was <100/uL and still on secondary prophylaxis.
49 patients had followed up to 48 weeks. At 48 weeks of antiretroviral therapy,
42 from 49 (85.7%) had CD4 >100/uL and undetectable HIV RNA. 20 from 42
patients were in group B and discontinued secondary prophylaxis for a median
duration of 12 weeks (24 weeks in 8 patients). There was no relapse of cryptococcal meningitis in both groups at the end of 48 weeks.
Conclusion: It may be safe to discontinue secondary prophylaxis for cryptococcal meningitis when the patients achieve CD >100/uL and undetectable HIV RNA
and sustained for at least 3 months. However, longer duration of following up is
required to ensure the long-term safety
Presenting author: Asda Vibhagool, Department of Medicine, Ramathibodi
Hospital, Rama 6 Road, Bangkok, 10400, Thailand, Tel.: [phone], Fax:
[phone], E-mail: raavb@ mahidol.ac.th
ThPeB7293 Cryptococcosis in children with AIDS: A 69-case
report
P. Kosalaraksa, C. Pancharoen2, R. Hansudewechakul3, V. Sirisanthana4,
K. Chokephaibulkit5, W. Punpanich6, S. Hongsiriwon7, R. Somsamai8,
C. Ngampiyaskul9, R. Lolekha5, P. Lumbiganon1. 'Khon Kaen University,
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen
40002, Thailand; 2 Chulalongkorn University, Bangkok, Thailand; 3Chiang Rai
Hospital, Chiang Rai, Thailand; 4Chiangmai University, Chaingmai, Thailand;
5Siriraj Hospital, Bangkok, Thailand; 6Queen Sirikit National Institute of Child
Health, Bangkok, Thailand; 7Chonburi Regional Hospital, Chonburi, Thailand;
8Lamphun Hospital, Lumphun, Thailand; 9Phrapokklao Hospital, Chantaburi,
Thailand
Cryptococcal infection is one of the most common opportunistic infections in HIVinfected adult. However, previous data suggested that it was not common in HIVinfectious children with few numbers of case reports or case series.
We retrospectively review cryptococcosis in HIV-infected children from 9 Thai government hospitals during 1996-2000. Demographic data, clinical data, immunologic features, and treatment outcomes were reviewed.
There were 69 cases of cryptococcosis, 50 males and 19 females. The median age at diagnosis was 76 months (24-168 months). Sixty percent (41/69)
of cases were between 6-12 year-old. The median CD4+ T-lymphocyte count
was 20 cells/ul, (0-777 cells/ul). Only 9 cases received antiretroviral drugs,
mostly zidovudine and didanosine. The clinical classifications were 26 meningitis,
25 disseminated infection (mostly meningitis and fungemia), and 18 fungemia.
Headache(87%) was the most common symptom followed by fever(80%) and
convulsion(29%). Nuchal rigidity and the change in mental status were found
54% and 34% respectively. The cerebrospinal fluid(CSF) profiles showed high
open pressure(71%), low sugar(82%), normal protein(59%). The organisms were
detected from CSF 21/21(100%) by indian ink preparation and 24/24(100%) by
antigen detection. Of the 53 available records, 43 were treated with amphotericinB
and 3 were treated with fluconazole. Seven were not treated due to the culture
results came after death. Fourteen cases were dead during initial treatment, 7
cases refused treatment. There were 10 relapses resulted to 4 deaths. The overall mortality rate including patients who refused treatment was 47%(25/53 cases).

Conclusions: The emergence of cryptococcosis was increasing in pediatric
AIDS in Thailand. Due to its high mortality, pediatrician should aware, recognize
this infection, especially in HIV-infected children with fever and headache.
Presenting author: Pope Kosalaraksa, Department of Pediatrics, Faculty of
Medicine, Khon Kaen University, Khon Kaen 40002, Thailand, Tel.: [phone], Fax: [phone], E-mail: [email protected]